NEUROLOGICAL ASSESSMENT

Name:- ______________________Age____________________________Sex_______________
Occupation:-_________________________________________________
Address:-________________________Contact:-____________________________________
Dominance:-_________________________________
Diagnosis:-___________________________________
Co.Morbidity(includes all risk factors any associated illness):-___________________________________________________________________________________
___________________________________________________________________________________
History Of Present Illness:-
(onset,progression,history till date)
___________________________________________________________________________________
___________________________________________________________________________________
Past History:-__________________________________________________________________
___________________________________________________________________________________
Medical History:-_______________________________________________________________
Personal History:-______________________________________________________________
Family History:-________________________________________________________________
Social History:-_________________________________________________________________

EXAMINATION:-
1.General Examination:-
(include vitals)

2.Higher Functions:-
          #Glassgow Coma Scale
                                        * Eye opening
                                        * Verbal response
                                        * Motor response
           #Mini Mental Scale
           #Speech,Vision,Hearing,Intelligence,Behaviour.
3.Cranial Nerve Examination:-
   Tone :- Ashworth Scale
4.Sensory Examination:-
(Normal,Reduced,Absent)
___________________________________________________________________________________
#Superficial Sensations                     #Deep Sensations
Pain___________________                           Joint Position Sensation
Temperature____________                           Proximal,         Distal
Crude Touch_____________                          Vibration,
Pressure__________________                       Perception:Depth,Height,Space,Distance
                                                       Body IMAGE -size,shape,colour
#Cortical Sensations:-
    *Tactile Localisation
    *2 Point Discrimination
    *Graphesthesia
    *Steriognosis
    *Cortical Extn
    *Barognosis

5.Reflexes:-              Right                      Left
   Biceps
   Triceps
   Supinator
   Knee
   Ankle
   Plantar
6.Motor Examination:-____________________________________________________
  #Nutrition:-______________________________________________________________
                   (Skin                                          Muscle girth)
 #Tone:-
             *Hypotonia:-
           
             *Hypertonia:- Spasticity                         Rigidity
                                                         1.Lead Pipe       2.Cog Wheel
 #ROM & Tightness:-
 #Contracture:-
   (include Limb Length if required)

7.Involuntary Movements:-
                    Tremors:-At Rest/Activity
                    Athetosis/Chorea/Dystonia/Associated Reaction/Hemiballismus
                    Associated Reaction

8.Voluntary Control:-

9.Test For Co ordination:-

10.Stream Format(sheet attached):-

11.Posture:-
     In case of in-patient,bed-redden patient:Posture-more of attitude of
     patient and Berg Balance Scale:-
12.Strategy Assessment:-

13.GAIT Assessment:-(Dynamic Gait Index),Balance

14.BARTHEL'S INDEX:-

15.Investigation and Drug history

ICDIH2:-

Diagnosis:-

Mnagement:- STG                                         LTG


Follow Up:-

exercises to prevent arthritis